Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
BMC Pediatr. 2023 Oct 28;23(1):537. doi: 10.1186/s12887-023-04360-z.
Children with congenital heart disease (CHD) are easily complicated by severe pneumonia and heart failure. We aimed to conduct a meta-analysis to evaluate the effects and safety of milrinone for the treatment of heart failure caused by severe pneumonia in children with CHD to provide evidence for the clinical CHD treatment.
Two authors searched MEDLINE, PubMed, Embase, Science Direct, Cochrane Central Register of Controlled Trials, the Cochrane Library, Wanfang database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI) for randomized controlled trials (RCTs) about the application of milrinone in the treatment of heart failure caused by severe pneumonia in children with CHD in children up to December 10, 2022. Two evaluators independently selected the literature, extracted data and evaluated the methodological quality, meta-analysis was carried out with RevMan 5.3 software.
Eight RCTs involving 680 CHD children complicated by severe pneumonia and heart failure were included in this meta-analysis. Meta-analysis indicated that total effective rate of the milrinone group was higher than that of control group (RR = 1.25, 95%CI: 1.17 ~ 1.34, P < 0.001), the time to stable heart rate of the milrinone group was less than that of control group (RR=-0.88, 95%CI: -1.09~ -0.67, P < 0.001). The time to stable respiration of the milrinone group was less than that of control group (RR=-0.98, 95%CI: -1.17~ -0.78, P < 0.001). The LVEF of the milrinone group was higher than that of control group (RR = 6.46, 95%CI: 5.30 ~ 7.62, P < 0.001). There was no significant difference in the incidence of adverse reactions between the milrinone group and control group (RR = 0.85, 95%CI: 0.47 ~ 1.56, P = 0.061). Funnel plots and Egger regression test results indicated that there were no statistical publication bias amongst the synthesized outcomes (all P > 0.05).
Milrinone is beneficial to improve clinical symptoms and cardiac function and increase the therapeutic effect and safety in children with CHD complicated by severe pneumonia and heart failure. However, more RCTs with large samples and rigorous design are needed to verify this finding.
患有先天性心脏病 (CHD) 的儿童容易并发严重肺炎和心力衰竭。我们旨在进行一项荟萃分析，以评估米力农治疗 CHD 儿童严重肺炎引起的心力衰竭的效果和安全性，为临床 CHD 治疗提供证据。
两位作者检索了 MEDLINE、PubMed、Embase、Science Direct、Cochrane 对照试验中心注册库、Cochrane 图书馆、万方数据库、中国生物医学文献数据库、中国知网 (CNKI)，以获取截至 2022 年 12 月 10 日有关米力农治疗 CHD 儿童严重肺炎并发心力衰竭的随机对照试验 (RCT) 文献。两位评估者独立筛选文献、提取数据并评价方法学质量，采用 RevMan 5.3 软件进行荟萃分析。
本荟萃分析纳入了 8 项 RCT，共 680 例 CHD 合并严重肺炎和心力衰竭的患儿。荟萃分析表明，米力农组总有效率高于对照组（RR=1.25，95%CI：1.171.34，P<0.001），米力农组稳定心率时间短于对照组（RR=-0.88，95%CI：-1.09-0.67，P<0.001）。米力农组稳定呼吸时间短于对照组（RR=-0.98，95%CI：-1.17-0.78，P<0.001）。米力农组左心室射血分数 (LVEF) 高于对照组（RR=6.46，95%CI：5.307.62，P<0.001）。米力农组不良反应发生率与对照组无显著差异（RR=0.85，95%CI：0.47~1.56，P=0.061）。漏斗图和 Egger 回归检验结果表明，综合结局无统计学发表偏倚（均 P>0.05）。
米力农有利于改善 CHD 合并严重肺炎和心力衰竭患儿的临床症状和心功能，提高治疗效果和安全性。然而，需要更多样本量大、设计严谨的 RCT 来验证这一发现。
